A familiar outbreak

With Muzaffarpur as the epicentre, the horrific outbreak of AES is wreaking havoc in several districts of northern Bihar. The death toll has reportedly hovered over the century mark and the government has sprung into action with desperate measures on the cards. Most casualties fall in the age bracket of 1-10 which makes it an alarming situation since children remain more prone to virus outbreaks of this sort. Acute Encephalitis Syndrome (AES), locally referred to as 'Chamki' fever, usually occurs at higher temperatures exceeding 42 degree Celsius—peak summers. While the medical fraternity is engrossed in identifying the reason behind the outbreak – why AES cases have spiked – the state is striving to contain the epidemic. Local health authorities cited that the blood sugar levels of AES patients are quite low and a toxin contained in litchi fruit has been detected in urine samples from two-thirds of them. Union Health Minister Dr Harsh Vardhan said that 'extreme rise in the heat with humidity and litchi fruit' is the cause of the current AES outbreak and call for measures to address the grave adversity. Bihar Health minister Mangal Pandey and deputy health minister Ashwini Choubey accompanied him as the trio visited Shree Krishna Medical College and Hospital to take stock of the situation. Though Harsh Vardhan announced a slew of measures apart from ensuring the public that the Bihar government would open a high-quality research centre along with ICU with a 100-bed capacity by June 2020, his cavalcade was stopped by protesters, as he was returning from Muzaffarpur to Patna; black flags were waved at him. The agitated mood of the public may be pooled in as an expected response in times of crisis, it is not due to just this outbreak but rather a trend. In the past as well, similar outbreaks of AES have occurred and all that the government machinery has done since then is to take stock, initiate exigency measures and ensure expedited implementation in order to contain the outbreak—classic damage control. While exigency measures and restless hours spent by doctors around the clock to control the situation is appreciated, AES's annual trend fuels apprehensions. AES is not new for Bihar. It has struck the state in summer months for years. Back in 2014, a similar AES outbreak had caused numerous deaths. Even then, Union Health Minister, which happens to be Harsh Vardhan only, had visited the affected area and called for measures to control the crisis. Five years on and the Centre is still calling for exigency measures with no prevention plan available to avoid succumbing to the outbreak. It is widely reported that AES causes death almost every year in regions of Bihar during the summer months of June-August. Japanese Encephalitis virus remains the most common cause of AES in the nation but it can be caused by several viruses – typhus, dengue, mumps, measles, Nipah, Zika. Children suffering from AES develop a high fever in extreme heat. As their body temperature shoots up, they may suffer from convulsions, weakness, nausea, disorientation, memory loss, seizures and a possible coma. So the extent of symptoms and effects of AES are known which is a crucial input in containing AES. However, the question of why AES remains a trend in Bihar occurring every summer remains unanswered. While the cause is clinically unidentified in several cases, this year, autopsy reports of deceased in Bihar cites low blood-sugar levels and the toxin from litchi fruit. Research is required to corroborate this possibility while on a general note it must be taken into account that AES is not a state-specific epidemic. But then why Bihar depicts such a dismal situation with an alarming number of casualties? It is understood through several accounts that malnutrition in children aggravated by severe heat, humidity and poor hygiene remain prime reasons for the increasingly compounding situation. Bihar has a high frequency of malnourished children and this can possibly explain the grim situation there. While Jharkhand and eastern UP remain alerted over any scope of AES widespread in the area, Bihar has the mammoth task of containing the outbreak while pursuing research to identify the cause and spread awareness regarding the same.

Long-term planning is indeed desirable to prevent another AES outbreak. This calls for extensive research, preferably collaborated by WHO, to narrow down the cause and ensure survivability which remains a top priority. In all likelihood, AES outbreak will return and enough time has been poured down the stream with no concrete development to seize it upon its onset. Virology clinics and medical units to deal with AES must be opened in an expedited manner as Bihar undertakes emergency measures to contain the situation at hand. A tip or two from Kerala would work out right as far as containment is concerned while a joint effort to locate the prime cause and isolate it or prevent the onset of the outbreak remains the most important job right now.